Provider Demographics
NPI:1013022425
Name:MIYAKE, SCOTT KEOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KEOLA
Last Name:MIYAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6902 SE LAKE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2148
Mailing Address - Country:US
Mailing Address - Phone:503-786-1167
Mailing Address - Fax:503-786-1153
Practice Address - Street 1:6902 SE LAKE RD
Practice Address - Street 2:STE 100
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2148
Practice Address - Country:US
Practice Address - Phone:503-786-1167
Practice Address - Fax:503-786-1153
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045274207RN0300X
ORMD24235207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology